NPIMap

Individual provider Active NPI

Olufemi Olawale Fanusi

  • Family Nurse Practitioner
  • Stonecrest, GA
National Provider Identifier
1003561705
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN285470 Issued in GA
Practice address
4202 Kensington Cir
Stonecrest, GA 30038-3239
Phone
(678) 680-9209
NPI assigned
Feb 21, 2022
Sex
Male
Sole proprietor
No

Organizations & group practices 24

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Pruitthealth Hospice Inc 42 clinicians

Practice addresses (Care Compare)

1626 Jeurgens CT
Norcross, GA 30093-2219
Phone (404) 292-2081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20220721001872 GA Practitioner - Nurse Practitioner 4284015215 Reassigns benefits to 3 organizations
I20240605000964 TX Practitioner - Nurse Practitioner 4284015215 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN285470GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pruitthealth Hospice, Inc. CurrentSince Sep 15, 2025 Accepting new patients
Longevity Clinical LTC Associates of Texas, PLLC CurrentSince Jun 3, 2024 Accepting new patients
Resurgia Health Solutions PC CurrentSince Nov 7, 2022 Accepting new patients
Pruitthealth Hospice, Inc. CurrentSince Sep 15, 2025 Accepting new patients
Pruitthealth Hospice, Inc Current Accepting new patients
Py Medical Services of Ny PLLC CurrentSince Jul 7, 2025 Accepting new patients
Rite Med Group of Ga PC CurrentSince Jun 1, 2025 Accepting new patients
Physicians at Home PC Past Accepting new patients

Locations

1100 Peachtree St NE
Ste 200
Atlanta, GA 30309
Phone (404) 445-5304

1510 Renaissance Dr NE
Conyers, GA 30012
Phone (770) 483-4480

3051 Whiteside Rd
Macon, GA 31216
Phone (478) 347-2400

6060 Lakeside Commons Dr
Macon, GA 31210
Phone (478) 745-9204

1626 Jeurgens Ct
Norcross, GA 30093
Phone (770) 806-6875

7345 Red Oak Rd
Bldg 25
Union City, GA 30291
Phone (770) 254-8573

3438 Bell Blvd
Ste 301
Bayside, NY 11361

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN285470 GA Primary

Addresses

NPPES NPI Registry

Primary practice location

4202 Kensington Cir
Stonecrest, GA 30038-3239

Mailing address

4202 Kensington Cir
Stonecrest, GA 30038-3239
Phone (678) 680-9209

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 21, 2022.

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1003561705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 KENSINGTON CIR",
            "city": "STONECREST",
            "state": "GA",
            "postal_code": "300383239",
            "telephone_number": "678-680-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 KENSINGTON CIR",
            "city": "STONECREST",
            "state": "GA",
            "postal_code": "300383239",
            "telephone_number": "678-680-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANUSI",
        "first_name": "OLUFEMI",
        "middle_name": "OLAWALE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN285470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stonecrest, GA

Sources for this page

Verify at the official NPI Registry.